Please fill out our online referral form below.

 

    Client 1

    Details

    ApplicantRespondent


    Interview

    Please complete as fully as possible, e.g. working hours, flexibility, etc.


    Solicitor's details (if applicable)


    Legal

    Legally aided YesNoNot sure

    Liable to pay fees YesNoNot sure

    Client 2

    Details

    ApplicantRespondent


    Interview

    Please complete as fully as possible, e.g. working hours, flexibility, etc.


    Solicitor's details (if applicable)


    Legal

    Legally aided YesNoNot sure

    Liable to pay fees YesNoNot sure


    Court Proceedings

    Please give details, including court and hearing date.


    Key Dates


    Children

    Child #1

    Child #2

    Child #3

    Child #4


    New Partner


    Outline Of Situation

    Is there a history of domestic violence? YesNo

    Is there a history of child protection issues? YesNo


    Areas for mediation

    Please tick main issues.

    Pre-separation issuesChild arrangementsPost-divorce problemsReaction to divorce/separationFinance and propertyOther


    Is other party aware of referral? YesNo